BELGIUM 27th !!!

1) HTA DE GRADE 3 = TOUJOURS RISQUE > ELEVE

2) PREVENTION SECONDAIRE ou DIABETE + ATTEINTE ‘ORGANE CIBLE’/FACTEUR DE RISQUE = RISQUE ELEVE PEU IMPORTE LA PA 4 3

3) Si PAS >140 et/ou 90 mmHg et  >3 facteurs de risque CV  ou atteinte ‘organe cible’  ou diabète = RISQUE ELEVE

LIFE EXPECTANCY AT 60 YRS IN 2012

Ph van de Borne, L Missault, A Persu, W Van Mieghem for the COME STAI INVESTIGATORS

Parameters > 2 medications 1 medication 0 medication Systolic BP (mmHg) 139±19139±18143±21* Diastolic BP (mmHg) 80±1181±1183±13* Age (years) 68±1262±1355±15* Heart rate (bpm) 72±1073±975±10* Body mass index (kg/m²) 29.0± ± ±5.2* S: systolic; D: diastolic; BP: Blood pressure; bpm: beat per minute; * p< RESULTS (2): Nr of medications reported in n:7961 patients (0 vs. 1 vs. 2 or more drugs)

Less intense treatment in the elderly : Among 495 patients aged ≥80 years, and SBP> 140 mmHg, therapy was intensified: in 57% when SBP > 160 mmHg (n=130) in 17% when 140 <SBP<159 mmHg* (n=365) *p Chi² <0.0001

Comparison of Hypertension Guidelines Blood pressure in mm Hg ESH/ESC 2013[3] ASH/ISH 2014 [4] Go A. et al. AHA/ACC/CDC 2013 [5] 2014 Hypertension guidelines, US “JNC 8” [6] Definition of Hypertension ≥140/90 Not addressed Drug therapy in low risk patients after non- pharmacologic treatment ≥140/90 < 60 y. ≥140/90 ≥ 60 y. ≥150/90 Beta-blockers as first line drug Yes No (Step 4) No (Step 3) No (Step 4) Diuretic thiazides chlorthalidone, indapamide thiazides chlorthalidone indapamide thiazides thiazides chlorthalidone, indapamide Initiate drug therapy with two drugs If markedly elevated BP ≥160/100 Blood pressure targets <140/90 Elderly < 80 y. SBP SBP <140 in fit patients Elderly ≥ 80 y. SBP <140/90 ≥ 80 y. < 150/90 <140/90 Lower targets may be appropriate in some patients, including the elderly < 60 y. <140/90 ≥ 60 y. <150/90 Blood Pressure target in patients with diabetes mellitus < 140/85<140/90 Lower targets may be considered <140 /90 Lindholm LH, Carlberg B. HT News 2014, Opus 35